Purchase of Services Dbq Main STreet Ltd
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MEMORANDUM
May 27, 2005
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Purchase of Service Agreement -- Dubuque Main Street, Ltd.
During the Fiscal Year 2006 budget process, the Mayor and City Council provided
$43,966 for a Purchase of Service Agreement with Dubuque Main Street, Ltd.
Budget Director Dawn Lang is recommending execution of the attached Purchase of
Service Agreement with Dubuque Main Street, Ltd. to provide funding for the agency to
continue to implement a downtown revitalization program.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
A)~AiL
Michael C. Van Milligen
MCVM/ksf
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Dawn Lang, Budget Director
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MEMORANDUM
May 27, 2005
TO:
Michael C. Van Milligen, City Manager
FROM:
Dawn Lang, Budget Director
SUBJECT: Purchase of Service Agreement with Dubuque Main Street, Ltd.
The adopted Fiscal Year 2006 operating budget provides for the payment of $43,966 to
Dubuque Main Street, Ltd.
City funding enables the agency to continue to coordinate a downtown revitalization
program aimed at the creation and retention of jobs, prevention and elimination of slum
and blight, enhancement of the local tax base, and capturing of private investment.
It is my recommendation that the City Council approves the attached Purchase of
Service Agreement with Dubuque Main Street, Ltd. and authorizes the Mayor to
execute the contract on behalf of the City.
Attachment
DUksf
AGREEMENT
BETWEEN
CITY OF DUBUQUE, IOWA
AND
DUBUQUE MAIN STREET, LTD.
THIS AGREEMENT, dated for reference purposes the 1st day of July, 2005, is
made and entered into by and between the City of Dubuque, (City) and Dubuque Main
Street, Ltd., a nonprofit corporation (Agency).
WHEREAS, the City desires to engage the services of Agency to provide and
implement a downtown revitalization program; and
WHEREAS, Agency has indicated its willingness to provide such services to the
City;
NOW THEREFORE, the parties hereto agree as follows:
1. Scope of Services
Agency shall:
A. coordinate a downtown revitalization program aimed at the creation
and retention of jobs, prevention and elimination of slum and blight,
enhancement of the local tax base and the capturing of private
investment.
B. develop and conduct ongoing public awareness and education
programs designed to enhance appreciation of the district's
architecture and other assets.
C. work with appropriate public agencies at the local, state and federal
levels to obtain necessary funding for downtown revitalization
projects. These may include but not be limited to design assistance,
promotional publications, building rehabilitation, parking and public
improvements.
D. utilize the National Trust's Main Street project format, develop and
maintain data systems to track the process and progress of the
project. These include, but are not limited to, economic data
monitoring, individual building files, thorough photographic
documentation of all physical changes and information on job
creation and business retention.
E. The City of Dubuque, Grand Opera House and Dubuque Main Street
have collaborated on the installation and management of a sign on
1
8th Street. As agreed, the sign will be a public sign with an electronic
reader board for advertising public events, and will include
permanent signage for the Grand Opera House. The message
control center for the reader board shall be located in the offices of
the Grand, and the design may also include a remote center at City
Hall. Control and responsibility of the message center will be jointly
coordinated between the Grand, the City of Dubuque and Dubuque
Main Street. On-going maintenance will be the joint responsibility of
the Grand and the City of Dubuque. The Grand will be responsible
only for those elements of the sign that identify the Grand on the
structure. Insurance coverage for the sign will be included in the City
of Dubuque's existing policy.
2. Time of Performance
The term of this agreement shall be from July 1, 2005 through June 30,
2006.
3. Compensation
City will pay to Agency $43,966 as compensation for the services provided
by Agency, which payment shall constitute full and complete
compensation for such services. The compensation shall be paid by City
to Agency in four equal installments of $10,991.50, payable September
30,2005, December 30,2005, March 31,2006, and June 30, 2006 after
execution of this agreement by both parties and upon receipt by City of a
requisition for such sum from Agency.
4. Audit and Evaluation
A. Inasmuch as the funds to be provided to Agency by City are subject
to audit and performance evaluation, Agency will maintain books of
accounts conforming to accepted accounting standards, together
with necessary documentation to support all expenditures. The
records of Agency, including payroll accounts and other records of
disbursements and receipts and any other records relating to the
performance of the activities herein specified, shall be made
available for inspection by City or any certified public accountant
acting on behalf of City, in order to ascertain performance of Agency
under this Agreement. Agency agrees to retain such records for not
less than three (3) years following the termination of this Agreement.
5. Reportinq and Monitorinq
A. Agency shall render to City a monthly written report detailing its
activities. Such report shall be rendered no later than the fourth
Thursday of the succeeding month. Semi-annual reports will be
2
submitted to the City Council (January and July 2006) and an annual
report will be submitted within sixty (60) days of year end.
B. To aid in coordinating and directing the execution of this Agreement,
when deemed necessary, a monthly meeting will be held with
Agency staff and the Community and Economic Development
Department, and other parties deemed appropriate by City and
Agency. Such meetings will be held to insure proper communication
and avoid duplication of efforts between City and Agency.
6. Amendments and ChanQes in Scope of Services
Any changes in the Scope of Services contained in this Agreement must
have the prior written approval of City.
7. Discrimination
In carrying the services under this Agreement, Agency shall not
discriminate against any employee or applicant for employment because
of race, color, religion, sex, age, national origin or disability. Agency shall
take affirmative action to insure that applicants for employment are
employed, and that employees are treated during employment without
regard to their race, color, religion, sex, age, national origin, or disability.
Such action shall include, but not be limited to, the following:
employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of payor other forms of
compensation; and selection for training, including apprenticeship.
Agency shall post in conspicuous places, available to employees and
applicants for employment, notices to be provided by City setting forth the
provisions of this nondiscrimination clause. Agency shall state that all
qualified applicants will receive consideration for employment without
re~ard to race, color, religion, sex, age, national origin, or disability.
8. Interest of Officers or Employees of the City of Dubuque. Members of the
Dubuque City Councilor Other Public Officials
No officer or employee of City, or its designees or agents, no member of
the Dubuque City Council and no other public official of City who
exercises any function or responsibilities with respect to the program
during his tenure, or for one year thereafter, shall have any interest, direct
or indirect, in this Agreement or the proceeds thereof, for work to be
performed in connection with the program assisted under this Agreement.
9. Termination of Contract
If, through any cause, Agency shall fail to fulfill in timely and proper
manner its obligations under this Agreement, or if Agency shall violate any
of the covenants, agreements or stipulations of this Agreement, City shall
3
thereupon have the right to terminate this Agreement by giving written
notice to Agency of such termination and specifying the effective date
thereof at least five days before the effective date of such termination.
Upon termination of this Agreement Agency will return to City all
unexpended funds and/or any funds utilized for purposes other than
stated in this Agreement.
10. Compliance with Laws
Agency shall comply with all applicable laws, ordinances and codes of the
Federal Government, the State of Iowa, and the City of Dubuque.
11. Assiqnabilitv
Agency shall not assign any interest in this Agreement and shall not
transfer any interest in the Agreement without the prior written approval of
City.
12. Insurance
At the time of execution of this Agreement by Agency, Agency shall
provide the City copies of Agency's insurance certificates showing general
liability, automobile liability, and workers compensation insurance
coverage to the satisfaction of City for the term of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the
date first written above.
, WITNESSED:
Karen M. Chesterman, Deputy City Clerk
Date: June 6, 2005
CITY OF DUBUQUE, IOWA
Joyce E. Connors, Mayor Pro-Tem
Date: June 6, 2005
DUBUQUE MAIN STREET, LTD.
Dan LoBianco, Executive Director
5
· · AUG-23-2005 rUE 10:17 AM FRIEDMAN INSURANCE
FAX NO. 563 556 4425
CE:,RTIFICATE OF LIABILITY INSURANCE D~~/~;ir;;)
(563)556-0272 FAX (563)556-4425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
F MAN INSURANCE INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
202 FISCHER BUXi. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.o. BOX 759
DUBUQUE, IA 52004-1)759
INSURED Dubuque Main :, treet
909 Main Strel~t
2211 Fischer l~ui1ding
Dubuque, IA 5 :ZOOl
INSURERS AFFORDING COVERAGE
INSURER A: Westfield Companies
INSURER B;
NAIC.
p, 01
INSURER c:
INSURER 0:
INSUR~R J:~
COVERAGES
THE POLICies OF IIIlSURAN CE I-ISTED BELOW HAVE Bt;.EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIJCY PERIOD INDICATED. NOTWlTHSTAND1Nl
ANY REQUIREMENT. TERM OR cONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSUIU,NCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAve B!:EN REDUCED BY PAID CLAIMS.
~~ ~q;l TYPE OF 1N8URANCE POLICY I'lUMBE!R POLICY E;ffEQTIIfe POLICY I:XPlRATIOIt LIMITS
GENERAL LIABIU1Y BOP3065274 04/01/200S 04/01/2006 I:ACH OCCURReNCE s 1.000.0001
-
X COMMERCIAl- GE'fERAL LIABILITY DAMAGE TO RENTED ill SO. GOt
I CI.AIMS MAC~ 00 OCCUR MEO EXP (Anv gna pllt'llOn) $ . S.OOC:
A - PERSONAl. & NJV INJURV :Ii 1.000.00<
GENeRAL AGGREGATE $ 2.000.00(
- 2.000.00(
GEN'L AG~EnE LII~IT APPLI~S pER: PRODUCTS. COMP/OP AGG ~
I POLICV ~~~;: n LaC
I~TOM081L& LIABlLIT'f CWP3635257 04/01/2005 lM/01/2006 COMBINEO SINGLE LlMrT
(Ea IOCCtdllnl) $ 1 ,000 , OOC:
..!- ANY AUTO
I- ALL OWNED AUT':lS OOOlL Y INJURY .
(Per person) .
SCHEDULED AUlI:>S
A I--
HIRED AUTOS BODILY INJURV
f-- $
NON.OWNEO AUTOS (Plll' ;wl:C\d8t\l)
---
PROPERTY DAMAGE I:
(Per accident)
RRAGE LIABlUTY AUTO ONLY - EA ACCIDENT ,
ANY AUTO OTHER THAN EAACC S
AUTO ONLY: AGG is
SlCCES8/UMBRELLA LIAIltLlTY CWP36l5Z57 04/01/2005 04/01/Z006 eACH OCCURRENCS $ 2 ,000.00(]
::J OCCUR [] CLAIMS MADE AGGREGATIO S 2 OOO,OOfl
A $
R DEDUCTIBLE :5
RETENTION ~ $
w~I(ER8 COMPI:NBATIONAND WCP5385156 04/01/2005 04/01/2006 I WC STATU- ;1 lOJ.t'"
E....LOVelts" LIAIILlTY E,L. eACH ACCIDEN'!' $ 100 _ 00l
A ANV PROPRIE"ORIPARTNeI;I/EXECUTIVJ:
OFFICERlMEM8~R EXCLUDI!:D? E,L. DISEASE - eA eMPLOyE' c 100.00(
If V86, dNllfil>o LIIlder 500 .oe)(
SPECIAL PROVISIONS llIlIO\\ E,L. OISEAse. POLICY LIMIT :5
OTHER
DESCRIPTION OF OPEiRAT1ONS / LOCATIONS I VEIlICL/;S / &XCWSl0N8 ADDED BY ENDORSEMENT I SPECIAl. PftOVl$lON9
,
Mark
C
C
CITY OF DUBUt~E
CITY HALL
50 W 13TH ST~EET
DUBUQUE. IA 52001
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
AUG-23-2005 rUE 10:17 AM FRIEDMAN INSURANCE
FAX NO, 563 556 4425
P. 02
IMPORTANT
If the c81tificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBRDGATION IS WAIVED, subject to the terms and conditions or the policy, certain policies may
require eln endorsement. A statement on this certificate does not confer rights to the certificate
holder irllieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the rellerse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer. and the certificate holder, nor does It
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 2S (2001/08)
The
~ FRIEDMAN
GROUPINC
DUBUQUE MAIN STREET
RENEWAL SUMMARY
APRIL 1, 2005
BUSINESSOWNERS
PROPERTY
Contents
Money & Securities - Inside
- Outside
Employee Dishonesty
Computer Coverage
Deductible
Business Income w/Extra Expense
Deductible
Policy Form
Valuation Method
GENERAL LIABILITY
Each Occurrence Limit
Fire Damage Legal Limit
Medical Payment Limit
Hired/Non-Owned Auto Liability
Additional Insured:
City of Dubuque
Includes Special Events
TOTAL BUSINESSOWNERS PREMIUM
Friedman f11S11rance, fnc.
Friedman Financial Services, fnc.
-...--.-..-.,.-- >----------..------------.--..".---..------.-..." .- .
202 Fischer Building, P.O. Box 759, Dubuque, IA 52004-0759
Phone: (563) 556-0272 F;L'c (563) 556-4425
e-mail: info@friedman-group.com
2004-2005
$ 31,000
5,000
2,500
50,000
13,094
250
ALS
o
Special
RC
$1,000,000
50,000
5,000
1,000,000
YES
YES
$
755
2005-2006
$ 31,000
5,000
2,500
50,000
13,094
500
ALS
o
Special
RC
$1,000,000
50,000
5,000
1,000,000
YES
YES
$
757
,- ,/~:=:~,'~,
:-~>rc'd (hoice \ II"",,,,....
'~._~'~~:'~ -
..
2004-2005 2005-2006
INLAND MARINE
Christmas Decorations $ 4,562 $ 4,562
Portable Stage '15,500 15,500
Deductible 500 500
Policy Form Special Special
Valuation Method ACV ACV
------------ -----------
Total Inland Marine Premium $ 678 $ 693
AUTOMOBILE
Liability
Medical Payments
UM & UIM
Comprehensive Deductible
Collision Deductible
$1,000,000
5,000
N/A
250
500
$1,000,000
5,000
N/A
250
500
2005 Pace AM Cargo Trailer - #1154
------
------
------
------
TOTAL AUTOMOBILE PREMIUM
$ 223
$ 201
UMBRELLA
Liability Limit
General Aggregate Limit
Self-Insured Retention
TOTAL UMBRELLA PREMIUM
WORKERS COMPENSATION
Employers Liability Limits
Bodily Injury by Accident,
Policy Limit - Disease
Each Employee - Disease
Classification
#8742 - Salesperson
#8810 - Clerical
Terrorism Coverage
TOTAL WORKERS COMPENSATION PREMIUM
* Per 2003-2004 Audit
TOTAL INSURANCE PREMIUM
2004-2005
2005-2006
$2,000,000
2,000,000
WAIVED
$2,000,000
2,000,000
WAIVED
$
$ 1,500
1,500
$ 100,000 $ 100,000
500,000 500,000
100,000 100,000
Pavroll Pavroll
$ 36,085 $ 40,000
45,969 47,000 *
Included Included
------------ ------------
$ 625 $ 658
--------
--------
--------
--------
$ 3,781
$ 3,809
-._,._- ...........--.....-. ----..-- -- ------'~---'-_.._-----~-------_.-.._-..__._..__.._----------.--.---------..-----.----.,. T
_ ~CDRQM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY)
04/14/2004
PRODUCER (563)556-0272 FAX (563)556-4425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
FRIEDMAN INSURANCE INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
202 FISCHER BLDG. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. BOX 759
. IBUQUE , IA 52004-0759 INSURERS AFFORDING COVERAGE NAIC#
.RED Dubuque Maln Street ltd INSURER A: Westfield Companies
909 Main Street INSURER B:
2211 Fischer Building INSURER C:
Dubuque, IA 52001 INSURER D:
INSURER E:
COVERAGF=~
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~!t ~q,~~ TYPE OF INSURANCE POLICY NUMBER PP.L!<2Y EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY BOP306S274 04/01/2004 04/01/2005 EACH OCCURRENCE $ 1,000,000
~
X COMMERCIAL GENERAL LIABILITY DAMAGE T9_RENTED $ 50,000
I CLAIMS MADE m OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,OOO,OOC
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,OOO,OOC
!xl POLICY n ~~8T n LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
f...-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON.{)WNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
.,
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
. =i ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
~ESS/UMBRELLA LIABILITY CWP3635257 04/01/2004 04/01/2005 EACH OCCURRENCE $ 2,000,000
X OCCUR 0 CLAIMS MADE AGGREGATE $ 2,OOO,OOC
A $
~ DEDUCTIBLE $
X RETENTION $ ( $
WORKERS COMPENSATION AND . I WC STATU- I IO,,1f,i-
EMPLOYERS' LIABILITY
ANY PROPRIETORlPARTNERlEXECUTlVE E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? E.L. DISEASE. EA EMPLOYE $
W yes, describe under
SPECIAL PROVISIONS below E. L. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
FISCHER COMPANIES
P.O. BOX 267
DUBUQUE, IA 52004-0267
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
E INSURER, ITS AGE TS OR REPRESENTATIVES.
ATlVE .A.
^' .,t.f h. ~- J
Richard F
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
.- , Westfield Companies
j . ;' One Park Circle PO Box 5001
-.r ~F Westfield Center OH 44251-5001
COMPANY PROVIDING COVERAGE
ITEM NAMED INSURED & MAILING ADDRESS
1. DUBUQUE MAIN STREET LIMITED
909 MAIN ST
DUBUQUE IA 52001
STANDARD WORKERS COMPENSATION 42
AND EMPLOYERS LIABILITY POLICY
INFORMATION PAGE- RENEWAL
WESTFIELD INSURANCE COMPANY (14451)
AGENCY 14-02300 000
FRIEDMAN INSURANCE INC
PO BOX 759
DUBUQUE IA 520040759
TELEPHONE 563-556-0272
POLICY NBR: WCP 5 385 156
OTHER WORKPLACES NOT SHOWN ABOVE:
Federal ID# 421260305
2. Policy FROM 04/01/05
Period TO 04/01/06
None
Named Insured is: CORPORATION
at 12:01 A.M. Standard Time at
your mailing address shown above.
3A. Workers Compensation Insurance: Part One of the policy applies to the
Workers Compensation Law of the states listed here: IOWA
3B. Employers Liability Insurance: Part Two of the policy applies to work in
each state listed in item 3A. The limits of our liability under Part Two
are:
Bodily Injury by Accident
Bodily Injury by Disease
Bodily Injury by Disease
$100,000 each accident
$500,000 policy limit
$100,000 each employee
3C. Other States Insurance: Part Three of the policy applies to the states
listed here: all states except North Dakota, Ohio, Washington,
West Vir~inia, Wyoming, and States designated in Item 3A. of the
Informat1on Page.
3D. This policy includes these endorsements and schedules:
WC-OOOOOOA 04/92*, WC-000414 07/90*, WC-000419 01/01*,
WC-000112 09/04*, WC-000420 12/02*
4. The premium for this policy will be determined by our Manuals of Rules,
Classifications Rates and Rating Plans. All information required below 1S
subject to verification and change by audit.
Code Estimated Per $ 100 Estimated
CLASSIFICATION OF OPERATIONS Total Annual of Annual
Number Remuneration Remuneration Premiums
SALESPERSONS, COLLECTORS, OR 8742 40,000 .59 $236
MESSENGERS - OUTSIDE
CLERICAL OFFICE EMPLOYEES NOC 8810 47,000 .29 136
SUB-TOTAL 372
TOTAL SCHEDULE OF OPERATIONS PREMIUM $372
Minimum Premium $332 Expense Constant $260
9740 - Terrorism Insurance Coverage $26
Total Estimated
Annual Premium
$658
PAGE 01 OF 01
02/16/05
ORIGINAL
Westfield Companies
_ One Park Circle PO Box 5001
Westfield Center OH 44251-5001
42
COMMERCIAL PACKAGE POLICY
RENEWAL
COMMON POLICY DECLARATIONS
COMPANY PROVIDING COVERAGE
NAMED INSURED AND MAILING ADDRESS
DUBUQUE MAIN STREET LTD
909 MAIN STREET
DUBUQUE IA 52001
WESTFIELD INSURANCE COMPANY
AGENCY 14-02300
FRIEDMAN INSURANCE INC
PO BOX 759
DUBUQUE IA 52004-0759
TELEPHONE 563-556-0272
000
POlicy Number: BSP 3 635 257
Policy From 04/01/05
Period To 04/01/06
Business: MERCHANTS ASSOCIATION
1101
at 12:01 A.M. Standard Time at your
mailing address shown above.
Named Insured is: NON-PROFIT ORGANIZAT
In return for the payment of the premium, and sUbject to all terms of this
pOlicy, we agree with you to provide the insurance as stated in this policy.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS
COMMERCIAL AUTO COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL UMBRELLA COVERAGE PART
TERRORISM INSURANCE COVERAGE
I
201. 00
693.00
1,500.00
0.00
Pol,icy Annual Premium
$
2,394.00
Total Advance Annual Policy Premium
$
2,394.00
The above is a summary of your coverages. For more detail,
please refer to the individual coverage parts inside your policy.
Forms and Endorsements applicable to all coverage parts:
IL0019 0488, IL0017 1198, ID7004 0893*, IL0003 0702, IL0276 0702.
COUNTERSIGNED:
3~( ->-6 )
Date
IL 00 19 (04-88)
BY
4~~~
Auttior1zed Representative
02/28/05 ORIGINAL
PAGE 01 OF 01
. Westfield Companies 42
. . ~ One Park Circle PO Box 5001 RENEWAL
- ,f ~ - Westfield Center OH 44251-5001 BUSINESS AUTO COVERAGE DECLARATIONS
COMPANY PROVIDING COVERAGE WESTFIELD INSURANCE COMPANY
ITEM ONE-NAMED INSURED & MAILING ADDRESS AGENCY I 14-02300 I PROD. I 000
DUBU~UE MAIN STREET LTD FRIEDMAN INSURANCE INC
909 AIN STREET PO BOX 759 .
DUBUQUE IA 52001 DUBU~UE IA 52004-0759
TELE HONE 563-556-0272
Policy Number: BSP 3 635 257 110 I
Policy From 04/01/05 at 12:01 A.M. Standard Time at your
Period To 04/01/06 mailing address shown above.
ITEM TWO SCHEDULE OF" COVERAGES AND COVERED AUTOS
Each Of These Coverages Will Apply Only To Those "Autos" Shown As Covered "Autos".
"Autos" Are Shown As Covered "Autos" For A Particular Coverage By The Entry Of One
Or More Of The Symbols From The Covered Auto Section Of The Business Auto
Coverage Form Next To The Name Of The Coverage.
COVERED LIMIT
COVERAGES AUTO THE MOST WE WILL PAY FOR ANY PREMIUM
SYMBOLS ONE ACCIDENT OR LOSS
Liability 07 Bodily Injury $45
and $1,000,000 Each Accident
Property Damage
Auto Medical Pay. 02 $5,000 $3
Physical Damage 07 Actual Cash Value or Cost of Repair $58
Comprehensive Whichever is Less Minus the Ded. for Each
Coverage Covered Auto as Indicated in the Schedule
for Covered Autos. No Deductible Applies
to Loss Caused by Fire or Lightning.
Phrsical Damage 07 Actual Cash Value or Cost of Repair $95
Co lis ion Whichever is Less Minus the Deductible
Coverage for Each Covered Auto as Indicated in the
Schedule for Covered Autos.
I TOTAL ADVANCE ANNUAL PREMIUM $201
Audit Period (If Applies) D Annual D Semi -Annual D Quarterly D Monthly
Forms And Endorsements Attached To This covera~e Form:
CAOO01 1001 CADS03 0204 , CA7001 0797 , I 0021 0702, CA0038 1202*
CA2356 1102*; CA0160 0203 , CA0051 1204, CA9903 0797, CA7007 1087 ~
PAGE 01 OF 02
CA DS 03 (02-04)
02/28/05
ORIGINAL
. Westfield Companies
. . One Park Circle PO Box 5001
- ,. ~ Westfield Center OH 44251-5001
COMPANY PROVIDING COVERAGE
ITEM ONE-NAMED INSURED & MAILING ADDRESS
DUBUQUE MAIN STREET LTD
909 MAIN STREET
DUBUQUE IA 52001
42
RENEWAL
BUSINESS AUTO COVERAGE DECLARATIONS
(Continued)
WESTFIELD INSURANCE COMPANY
AGENCY I 14-02300 1 PROD. I
FRIEDMAN INSURANCE INC
PO BOX 759
DUBUQUE IA 52004-0759
TELEPHONE 563-556-0272
000
Policy Number: BSP 3 635 257 1101
POlicy From 04/01/05 at 12:01 A.M. Standard Time at your
Period To 04/01/06 mailing address shown above.
ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN
The Insurance Afforded For Any One Automobile Is Only With Respect To Such And
So Many Of The Coverages As Are Indicated In Item Two Unless A Specific Limit Or
Deduct1ble Is Indicated In This Schedule Of Automobiles.
COST STATED
AUTO ST TER YR DESCRIPTION SERIAL NUMBER AGE SYM CLASS AMT GVW
001 IA 012 05 PACE AM CARGO TRL 40LUB16265P111l54 1 8600 68199
05000
PREMIUMS- FPB/ MED UN-UD SPEC TOW & . DEDUCTIBLE TOTAL
AUTO LIAB PIP PPI PY/EX MTRST COMP PERIL COLL LABOR ENDTS COMP COLL PREMIUM
001
$45
$3
$58
$95
250 500
$201
$201 I
ITOTAL ADVANCE ANNUAL AUTO PREMIUM
PAGE 02 OF 02
CA DS 03 (02-04)
02/28/05
ORIGINAL